USEFUL RESOURCES

Consortium for Research
On Unsafe Abortion in Africa

The purpose of this website is to be a place for researchers interested in abortion issues in Africa to share resources such as study designs and instruments, bibliographies and reports.

The overarching goals of the Consortium are to: 1. improve understanding of the prevalence, causes and consequences of unwanted pregnancy and unsafe abortion; 2. provide evidence to support actions to reduce unwanted pregnancy and unsafe abortion; and 3. increase women’s access to high quality, comprehensive, safe abortion care, within the limits of the law, and post-abortion care. The Consortium will foster high-quality policy and program-relevant research on unwanted pregnancy and abortion in selected countries, disseminate scientific findings broadly, support capacity building, and build a network of researchers to facilitate sharing of skills and information.

FEATURED STUDIES

Despite Zambia having one of the most liberal abortion policies in sub-Saharan Africa, rates of unsafe abortion remain high. The aim of this study is to establish how investment in abortion services impacts on the socio-economic conditions of women and their households, and the implications for policy-making and service provision in Zambia. What are the indirect and direct socio-economic costs of safe abortion compared to hospital-based PAC following an unsafe abortion for women and their households? What role does poverty play in termination of pregnancy trajectories? What are the social benefits and costs of using formal safe abortion services compared to informal unsafe abortion methods? Why is the investment in safe abortion services in Zambia not fully used by women seeking to terminate a pregnancy?

The research uses an innovative mixed methods longitudinal design. During the first phase of the project women seeking termination of pregnancy or post-abortion care at University Teaching Hospital in Lusaka are interviewed. These interviews combine quantitative and qualitative techniques in one interview. The participant is interviewed by two researchers, one who takes the lead using a conventional interview schedule in the manner of a qualitative semi-structured interview, while the second listens and, where possible, completes the quantitative ‘data sheet’. After interviewer one has completed the qualitative part of the interview, interviewer two takes over and asks the participant any remaining questions not yet answered on the data sheet. The quantitative data will be used to establish the distribution of out-of-pocket expenses, for women and their households, incurred using hospital-based safe abortion and PAC services. Qualitative data will establish the range of reasons why women sought abortion, and why they used or did not use safe abortion services, and to explore the social costs and benefits of their trajectories, and the policy implications. Follow-up qualitative interviews will be conducted to examine the on-going socio-economic trajectories in a sub-group of interviewees. Finally, to improve the quality of the research interpretation and findings, and the likelihood of policymaker impact, interviews with policy makers will also be conducted.

HEALTH SYSTEM COSTS OF UNSAFE ABORTION IN RWANDA

Beginning in 2011, Guttmacher Institute, in collaboration with the School of Public Health, National University of Rwanda, initiated a study of the costs to the health system in Rwanda of unsafe abortion, in particular the costs of post-abortion care (PAC). To assess health-system costs, two questionnaires have been developed, one that collects data on drugs and supplies used in treating five post-abortion complications, and a second which collects information on labor inputs as well as overhead and capital costs. Manuals for interviewing and data entry as well as data entry templates have also been prepared.

The study builds on a recently completed research project with the School of Public Health, National University of Rwanda, which estimated the incidence of abortion in Rwanda. Using the sampling frame developed by that project, 39 health institutions were randomly selected in a multistage process which assured coverage of the country’s five regions and the different levels of health care. Data were collected in May-July 2012 and data-entry and data cleaning phases were finished by mid-September 2012. Data analysis was in an advanced stage by mid-November 2012. The research team expects to submit a substantive article to a peer-reviewed journal by the end of 2012.

Kenya Abortion Incidence and Complications Study

Abortion is legally restricted in Kenya, permitted only when it is aimed at preserving the health of the mother. Unsafe abortion remains one of the leading causes of maternal mortality and morbidity in the country. Annually, about 3000 Kenyan women of reproductive age die of complications of unsafe abortion. The treatment of complications of abortion consumes a disproportionate amount of health system resources in Kenya as evidenced by a large number of admissions in tertiary hospitals which require long hospital stays, intensive care, and attendance by scarce highly-skilled medical personnel. New quantitative and qualitative data will provide information to fill gaps in knowledge on the current level of induced abortion, the severity of abortion complications, as well as women's abortion-seeking behavior in Kenya.

Ghana Health Provider’s Survey

The aim of this project is to assess the role of policy interventions for improving comprehensive abortion care services in developing countries. In an effort to reduce the maternal mortality and morbidity rates in Ghana, the Government of Ghana implemented a program called Reducing Maternal Mortality and Morbidity (R3M) on a pilot basis in 7 districts across 3 regions. A key aim of the R3M program is to train abortion providers in the provision of safe abortion care services, to sensitize them to the problem of maternal mortality and morbidity due to unsafe abortion, and to improve the manner in which they approach and treat their clients. In collaboration with the Institute for Statistical, Social, and Economic Research (ISSER) in Ghana, the Guttmacher Institute administered a survey of health care providers in the 7 pilot districts to get data on their knowledge, attitudes, and practices (KAP) in the area of comprehensive abortion care (CAC). The survey was also administered to providers in other districts in the country that hadn’t received the R3M intervention. By comparing providers in different parts of the country, we assess if there has been any change in the KAP of providers who were exposed to the R3M policy interventions.

Introducing Medical Abortion in Zambia: An Operations Research Study

Despite the broad grounds under which the Termination of Pregnancy Act of 1972 legalized abortion in Zambia, safe abortion services are not widely available, forcing many women to seek unsafe abortions. In 2009, the Ministry of Health, University Teaching Hospital, and Ipas undertook an operations research study in Zambia, primarily to introduce medical abortion and demonstrate models for safe abortion services and community interventions on safe abortion to the extent allowed by the law. The multi-pronged study included the introduction of clinical services in 28 facilities in Lusaka and the Copperbelt - including 121 clinical trainees, 80 pharmacy trainees, and eight intensive community-based organizations implementing interventions to introduce safe services. Evaluation of the pilot project was done using pre- and post-intervention mystery pharmacy client surveys, 906 post-intervention facility client exit interviews, and more than 800 pre-and post-intervention community household surveys.